3 ms·

You are of course correct on how we got here, I argue we are still here for many reasons, one of which is what I stated. I mean, there is no will to fix healthc

You are of course correct on how we got here, I argue we are still here for many reasons, one of which is what I stated. I mean, there is no will to fix healthcare, but lots of will to spend $100B+ to go to war with Iran, right? I simply do not see anyone who cares enough to fix this exceptional mess, even taking into account the coordination problem of doing so. We could treat this as an emergency requiring a fix, but we don't. Why? We can certainly find this will for, "low ROI nation state actions". Can we afford it? Doesn't stop trillions of dollars for DoD spending for middle east wars or tax cuts for the wealthy, so that isn't an argument, that's subjective cover for not fixing it, we do lots of things we cannot afford (current sovereign debt outstanding is ~$40T, as of this comment). Can't be done? Almost every other OECD country has solved this in some way. Therefore, as a scholar of systems, the root cause I am left with via Occam's razor is "This is an active choice to not fix this suboptimal system, where the fix would be both more economically efficient and humane, For Reasons while the electorate is lied to or paid lip service." Employers, who supposedly are unhappy with their healthcare costs, could form a coalition and lobby for legislation and fund PACs to fund candidates who would fix this state by state with universal healthcare systems (Canda's universal healthcare system started in a single province as an experiment, for example). Why don't they? Are the costs not high enough yet? They can't argue they don't have enough power, they already, in many ways, bend the US government to their will. They have the power, they actively choose to not use it to fix this system failure. https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_wha... https://en.wikipedia.org/wiki/Five_whys https://en.wikipedia.org/wiki/Five_whys

tptacek 2mo ago
We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.
- toomuchtodo 2mo ago
  The evidence shows we could spend less and deliver more within the scope of healthcare delivery (this piece). We actively choose not to. The Pentagon hasn't passed an audit eight years in a row, I hear little that "we cannot afford to keep funding the military at these levels and with such inefficiency." https://usafacts.org/government-spending/ https://usafacts.org/government-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget-is-discretionary-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget... https://www.militarytimes.com/news/pentagon-congress/2025/12/19/pentagon-fails-financial-audit-for-8th-year-in-a-row/ https://www.militarytimes.com/news/pentagon-congress/2025/12...
  - tptacek 2mo ago
    I don't want to sound like I'm fundamentally arguing with you, because if I could swap our system with Germany's I'd do so in a heartbeat. But (a) the "money that should be going into health care and education is going to military" argument is highly rebuttable, so I'd be careful hanging my hat on it, and (b) everybody, literally everybody (except the AMA) agrees we're spending too much on health care --- the problem is that money goes to practitioners, so it's very tricky to talk about clawing it back.
    - toomuchtodo 2mo ago
      I appreciate you keeping me honest on this topic.
      - tptacek 2mo ago
        Back atcha!
    - bonsai_spool 2mo ago
      > except the AMA What an idle comment - where is the AMA on record saying that we should spend more on healthcare? Here's all the work they do to describe our increasing costs: https://www.ama-assn.org/about/ama-research/policy-research-perspectives-national-healthcare-expenditures https://www.ama-assn.org/about/ama-research/policy-research-... Also, when people invoke the bogeyman of 'AMA' they treat it like the lobbies that tech companies belong to. The AMA is not enriching physicians or hospitals (which have their own lobby!) but generally espouses consensus perspectives among doctors while making money from administering things like a residency program application system. It's frustrating for someone like you to make this statement which feels quite divorced from any fact when you would not do the same about a security topic.
      - tptacek 2mo ago
        The AMA orchestrated the capping of residency slots through CMS/Medicare, which is the primary structural impediment to increased supply. Doctors in the US make integer multiples of what they do in Europe in part as a result of this. I have to say: you can go either way on the AMA, I guess, but it's a weird hill to die on, isn't it? They're a trade group, not a public health organization. They exist for the benefit of their members.

tptacek 2mo ago

We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.

toomuchtodo 2mo ago
The evidence shows we could spend less and deliver more within the scope of healthcare delivery (this piece). We actively choose not to. The Pentagon hasn't passed an audit eight years in a row, I hear little that "we cannot afford to keep funding the military at these levels and with such inefficiency." https://usafacts.org/government-spending/ https://usafacts.org/government-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget-is-discretionary-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget... https://www.militarytimes.com/news/pentagon-congress/2025/12/19/pentagon-fails-financial-audit-for-8th-year-in-a-row/ https://www.militarytimes.com/news/pentagon-congress/2025/12...
- tptacek 2mo ago
  I don't want to sound like I'm fundamentally arguing with you, because if I could swap our system with Germany's I'd do so in a heartbeat. But (a) the "money that should be going into health care and education is going to military" argument is highly rebuttable, so I'd be careful hanging my hat on it, and (b) everybody, literally everybody (except the AMA) agrees we're spending too much on health care --- the problem is that money goes to practitioners, so it's very tricky to talk about clawing it back.
  - toomuchtodo 2mo ago
    I appreciate you keeping me honest on this topic.
    - tptacek 2mo ago
      Back atcha!
  - bonsai_spool 2mo ago
    > except the AMA What an idle comment - where is the AMA on record saying that we should spend more on healthcare? Here's all the work they do to describe our increasing costs: https://www.ama-assn.org/about/ama-research/policy-research-perspectives-national-healthcare-expenditures https://www.ama-assn.org/about/ama-research/policy-research-... Also, when people invoke the bogeyman of 'AMA' they treat it like the lobbies that tech companies belong to. The AMA is not enriching physicians or hospitals (which have their own lobby!) but generally espouses consensus perspectives among doctors while making money from administering things like a residency program application system. It's frustrating for someone like you to make this statement which feels quite divorced from any fact when you would not do the same about a security topic.
    - tptacek 2mo ago
      The AMA orchestrated the capping of residency slots through CMS/Medicare, which is the primary structural impediment to increased supply. Doctors in the US make integer multiples of what they do in Europe in part as a result of this. I have to say: you can go either way on the AMA, I guess, but it's a weird hill to die on, isn't it? They're a trade group, not a public health organization. They exist for the benefit of their members.